What it is
Medicare Part D is prescription drug coverage for people who have Medicare. It is available as a stand-alone drug plan, often paired with Original Medicare and a Medigap policy, or it may be built into many Medicare Advantage plans. The plans are run by private insurance companies that contract with Medicare.
Every Part D plan has a formulary, which is the list of drugs the plan covers. Formularies usually sort drugs into tiers, and the tier a drug sits on can affect what you pay. Plans may also use rules such as prior authorization, quantity limits or step therapy before they cover certain drugs.
Plans also differ in their pharmacy networks, including preferred pharmacies and mail-order options. Details such as costs, covered drugs and rules vary by plan, carrier, state and year, so they are worth confirming directly. 2A Benefit does not sell plans or quote prices.<br>2A Benefit is not affiliated with the government or any government agency.
How it’s traditionally been approached
Many people have traditionally started by looking at the plans available in their area during the annual enrollment period each fall. They often review mailed plan materials, call carriers directly, or use the plan finder tool on Medicare.gov.
A common approach is to list every current prescription and the pharmacy you use. You then check whether each drug appears on a plan's formulary, which tier it is on, and whether any restrictions apply. People often repeat this check each year, because plans can change their formularies and rules.
Others work with a licensed insurance agent who can walk through the options. Some people choose a stand-alone Part D plan, and others choose a Medicare Advantage plan that includes drug coverage. Each route has trade-offs, and neither is right for everyone.
How the right agent may help
The right independent, licensed agent may help you sort through the many Part D choices in your state. A conversation is generally a chance to explain your situation, your medications and your pharmacy preferences, and to learn how different plans work. It does not replace advice from your doctor or pharmacist.
Questions you might ask include: Is each of my medications on the formulary, and on which tier? Are there prior authorization, quantity or step therapy rules? Is my pharmacy in the network, and is it preferred? How might the plan's rules change if my medications change? An agent may help you find the answers, but the plan documents and carrier are the final word.
It also helps to ask how the agent is paid, which carriers they are appointed with, and whether they can show you plans beyond those carriers. Insurance agents must be licensed in each state where they sell, and Medicare plans are sold by agents appointed with each carrier. Confirm any agent's license with your state insurance department. For current rules, you can also check Medicare.gov or call a licensed agent.
The bigger picture
Prescription medicines are often part of a daily routine, so a drug plan affects more than paperwork. Not knowing whether a medication will be covered can cause stress, and many people feel calmer once they have checked the formulary and understand how their plan works. Taking time to review your coverage each year may bring some peace of mind.
Your wellbeing and finances are connected, so it can help to talk with your doctor and pharmacist about your medications as well as with an agent about plans. If you are also looking for a care provider, Providers.plus may be one place to explore. Whatever you choose, there is no single right approach, and each person's needs are different.
Keep in mind
- 2A Benefit is an independent directory, not an insurer, and it does not sell policies. Licensed agents provide quotes and plan details.
- 2A Benefit is privately run and is not connected with or endorsed by the U.S. government, Medicare, CMS, Medicare.gov or HealthCare.gov.
- Formularies, costs, pharmacy networks and rules vary by plan, carrier, state and year, and they can change. Always confirm current details with the plan.
- This page is educational only and is not insurance, legal, tax, medical or financial advice. No plan is guaranteed to be the best choice or to be available to you.
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Frequently asked questions
What is Medicare Part D?
Medicare Part D is prescription drug coverage for people with Medicare, offered through private insurance companies. It can be a stand-alone plan or part of a Medicare Advantage plan. Costs, covered drugs and rules vary by plan, carrier, state and year.
How do I compare Medicare Part D plans?
You can compare Part D plans by listing your medications and pharmacy, then checking each plan's formulary, tiers, restrictions and pharmacy network. Medicare.gov offers a plan finder, and a licensed agent may also help you compare options. Confirm all details directly with the plan, since they change from year to year.
What is a formulary and how do I check it?
A formulary is a plan's list of covered drugs, usually sorted into tiers. To check it, look up each of your medications in the plan's current formulary and note any prior authorization, quantity limits or step therapy rules. The carrier, Medicare.gov or a licensed agent can help you confirm this.
Do I need a separate Part D plan with Medigap?
Generally yes. Medigap policies do not include prescription drug coverage, so people with Original Medicare and Medigap usually need a separate Part D plan if they want drug coverage. Many Medicare Advantage plans include drug coverage, but they have networks and other rules to weigh. Medicare.gov or a licensed agent can explain current rules.
When can I change my Medicare drug plan?
Most people can review and change their Part D plan during the annual enrollment period each fall. Some situations may allow changes at other times through special enrollment periods. Check Medicare.gov or speak with a licensed agent for the current rules that apply to you.
How can an agent help me compare Part D drug plans?
A licensed independent agent may help you compare Part D plans by reviewing your medications, your pharmacy and the formularies of plans available where you live. They may also explain how plan rules work. Confirm that the agent is licensed in your state with your state insurance department, and remember that no plan is guaranteed to suit everyone.
Educational resource. 2A Benefit shares general information and connects people with independent agents. It is not professional advice. Talk with a qualified professional about your own situation.